全内镜枕下锁孔入路血管减压术治疗面肌痉挛的体会

Fully endoscopy vascular decompression by the suboccipital key hole approach for treatment of hemifacial spasm

目的探讨全内镜枕下锁孔入路血管减压术治疗面肌痉挛的临床疗效。方法回顾性分析宁波市鄞州第二医院神经外科自2019年5月至2020年7月收治的面肌痉挛患者的临床资料。所有患者均于内镜下减压面神经根部(即出脑干区、离脑干区以及移行区)责任血管,术后随访5~19个月,评价其治疗效果。结果本组患者责任血管分为2类:(1)单一血管组:小脑前下动脉(AICA)共21例(60%);小脑后下动脉(PICA)共2例(5.7%);(2)复合血管组:AICA+PICA 4例(11.4%),PICA+椎动脉(VA)4例(11.4%),AICA+VA 3例(8.6%),AICA+PICA+VA 1例(2.9%)。所有患者均未见静脉压迫。术后痊愈者33例,明显缓解者2例。结论经枕下锁孔入路,内镜下可清晰观察面神经根以及责任血管并实施减压手术,术后效果良好。

Objective To discuss the fully endoscopy vascular decompression by the suboccipital key hole approach for treatment of hemifacial spasm(HFS).Methods The clinical data of 35 patients with HFS who were treated from May 2019 to July 2020 in Neurosurgery Department of Ningbo Yinzhou Second Hospital were analyzed retrospectively.All patients were treated with the vascular responsibility of decompression facial nerve root(i.e.the root emerging zone,the root exit zone and the transitional zone)under endoscope.All patients were followed up for 5-19 months and the therapeutic effect were evaluate.Results The offending vessels were divided into two groups:(1)single vessel compression,including anterior inferior cerebellar artery(AICA)21(60%),posterior inferior cerebellar artery(PICA)2(5.7%);(2)complex vascular compression,AICA+PICA 4(11.4%),PICA+VA 4(11.4%),AICA+VA 3(8.6%),AICA+PICA+VA 1(2.9%).No venous compression were observed in all patients.Thirty-three patients have excellent effect and 2 patients have a good effect.Conclusion Through the suboccipital key hole approach,the facial nerve root and responsible vessels can be clearly observed under endoscope,and decompression operation can be carried out.The postoperative effect is good.